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Importance and outcome relevance of central pathology review in prostatectomy specimens: data from the SAKK 09/10 randomized trial on prostate cancer


Abstract

OBJECTIVES: To conduct a central pathology review within a randomized clinical trial on salvage radiation therapy (RT) in the presence of biochemical recurrence after prostatectomy to assess whether this results in shifts of histopathological prognostic factors such as the Gleason Score.
PATIENTS AND METHODS: A total of 350 patients were randomized and specimens of 279 (80%) of the patients were centrally reviewed by a dedicated genitourinary pathologist. The Gleason Score, tumor classification and resection margin status were reassessed and compared with the local pathology reports. Agreement was assessed using contingency tables and Cohen's Kappa. Additionally, the association between other histopathological features (e.g. largest diameter of carcinoma) with rapid biochemical progression (up to 6 months after salvage RT) was investigated.
RESULTS: There was good concordance between central pathology review and local pathologists for seminal vesicle invasion [pT3b: 91%; k=0.95 (95% CI 0.89, 1.00)], for extraprostatic extension [pT3a/b: 94%; k=0.82 (95% CI 0.75, 0.89)], and for positive surgical margin status [87%; k=0.7 (95% CI 0.62, 0.79)]. Agreement was lower for Gleason score [78%; k=0.61 (95% CI 0.52, 0.70)]. The median largest diameter of carcinoma was 16 mm (range, 3-38 mm). A total of 49 patients (18%) experienced rapid biochemical progression after salvage RT. Largest diameter of carcinoma [odds ratio (OR): 2.04 (95% Confidence interval (CI): 1.30, 3.20); p = 0.002], resection margin status [OR: 0.36 (95% CI: 0.18, 0.72); p = 0.004] and Gleason score [OR: 1.55 (95% CI: 1.00, 2.42); p = 0.05] remained associated with rapid progression after salvage RT after backward selection.
CONCLUSION: The results of the central pathology analyses reveal concordant results for seminal vesicle invasion, extraprostatic extension, positive surgical margin but lower agreement for Gleason Score. Largest diameter of carcinoma was found to be a potential prognostic factor for rapid biochemical progression after salvage RT. This article is protected by copyright. All rights reserved.

Abstract

OBJECTIVES: To conduct a central pathology review within a randomized clinical trial on salvage radiation therapy (RT) in the presence of biochemical recurrence after prostatectomy to assess whether this results in shifts of histopathological prognostic factors such as the Gleason Score.
PATIENTS AND METHODS: A total of 350 patients were randomized and specimens of 279 (80%) of the patients were centrally reviewed by a dedicated genitourinary pathologist. The Gleason Score, tumor classification and resection margin status were reassessed and compared with the local pathology reports. Agreement was assessed using contingency tables and Cohen's Kappa. Additionally, the association between other histopathological features (e.g. largest diameter of carcinoma) with rapid biochemical progression (up to 6 months after salvage RT) was investigated.
RESULTS: There was good concordance between central pathology review and local pathologists for seminal vesicle invasion [pT3b: 91%; k=0.95 (95% CI 0.89, 1.00)], for extraprostatic extension [pT3a/b: 94%; k=0.82 (95% CI 0.75, 0.89)], and for positive surgical margin status [87%; k=0.7 (95% CI 0.62, 0.79)]. Agreement was lower for Gleason score [78%; k=0.61 (95% CI 0.52, 0.70)]. The median largest diameter of carcinoma was 16 mm (range, 3-38 mm). A total of 49 patients (18%) experienced rapid biochemical progression after salvage RT. Largest diameter of carcinoma [odds ratio (OR): 2.04 (95% Confidence interval (CI): 1.30, 3.20); p = 0.002], resection margin status [OR: 0.36 (95% CI: 0.18, 0.72); p = 0.004] and Gleason score [OR: 1.55 (95% CI: 1.00, 2.42); p = 0.05] remained associated with rapid progression after salvage RT after backward selection.
CONCLUSION: The results of the central pathology analyses reveal concordant results for seminal vesicle invasion, extraprostatic extension, positive surgical margin but lower agreement for Gleason Score. Largest diameter of carcinoma was found to be a potential prognostic factor for rapid biochemical progression after salvage RT. This article is protected by copyright. All rights reserved.

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Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Radiation Oncology
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:2017
Deposited On:12 Jan 2017 07:46
Last Modified:19 Feb 2018 07:30
Publisher:Wiley-Blackwell Publishing, Inc.
ISSN:1464-4096
Additional Information:This is the peer reviewed version of the following article: Ghadja P et al: BJU International, 17.12.2017, which has been published in final form at https://doi.org/10.1111/bju.13742. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving (http://olabout.wiley.com/WileyCDA/Section/id-820227.html#terms).
OA Status:Green
Free access at:Publisher DOI. An embargo period may apply.
Publisher DOI:https://doi.org/10.1111/bju.13742
PubMed ID:27987524

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